Skilled Nursing Facility Participation in Health Information Exchange and Quality of Care for Patients with Alzheimer's Disease and Related Dementias

熟练护理机构参与阿尔茨海默病和相关痴呆症患者的健康信息交流和护理质量

• 批准号: 10448802
• 负责人: Mark Aaron Unruh
• 金额: $ 37.68万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448802
• 关键词: Address; Admission activity; Adoption; Adverse event; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; Area; Back; Caring; Characteristics; Chronic; Clinical; Communities; Cost Savings; Data; Data Element; Data Sources; Dementia; Diagnosis; Discipline of Nursing; Etiology; Event; Face; Fee-for-Service Plans; Frequencies; Health; Health Care Costs; Health Promotion; Home; Hospitalization; Hospitals; Incentives; Income; Individual; Investigation; Length of Stay; Measures; Medical center; Medicare; Medicare claim; Medicare/Medicaid; New York; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physicians; Population; Provider; Quality of Care; Race; Research; Research Design; Research Priority; Sampling; Skilled Nursing Facilities; Symptoms; Time; Variant; acute care; adverse outcome; base; beneficiary; care coordination; care costs; cost; disparity reduction; dual eligible; functional improvement; health information technology; hospital readmission; improved; incentive program; income disparities; information organization; mortality; novel; payment; prevent; racial disparity; racial minority; readmission rates; residence

PROJECT SUMMARY/ABSTRACT Each year there are 1.5 million skilled nursing facility (SNF) stays for post-acute care among Medicare fee-for- service beneficiaries with Alzheimer’s disease or related dementias (ADRD), representing over 60% of beneficiaries who receive care in SNFs. ADRD patients often face unique challenges, including an inability to describe their diagnoses and symptoms or to participate in care planning, which may contribute to a higher likelihood of SNF use following hospitalization and poor outcomes. Following hospitalization, ADRD patients are four times more likely to be discharged to a SNF compared to patients without ADRD. SNF patients with ADRD have worse outcomes than other SNF patients, including higher re-hospitalization rates, longer SNF stays, and a lower likelihood of being discharged back to the community. Insufficient information-sharing capabilities between the SNF, the hospital, and other providers are thought to contribute to the frequency of these events. SNFs were not eligible to receive incentive payments through the Medicare and Medicaid EHR Incentive Programs that led to widespread adoption of health information technology among hospitals and physicians. HIE participation is now being actively promoted by policymakers as means to improve the quality of care in SNFs. However, there is no evidence of its ability to do so for SNF patients with ADRD. This is likely due to a lack of available data on SNF participation in HIE that includes key information, such as dates of HIE participation. In this project, a novel data source will be used that includes dates of HIE participation for all SNFs participating in HIE in New York State over an eight-year period (2012-2019). These data will be merged with a 100% sample of Medicare claims for all beneficiaries in the state who received care in SNFs during the study period to examine the relationship between SNF participation in HIE and the quality and the cost of care for patients with ADRD. The relationship between SNF participation in HIE and the quality of care will also be examined specifically for dual-eligibles and racial minorities with ADRD, who are more likely to receive fragmented care of lower quality compared to other Medicare beneficiaries. Our research design utilizes a difference-in-differences framework using the differential timing of SNF participation in HIE and incorporates an instrumental variable based on a patient’s residence and the differential distance between the nearest SNF with HIE and the nearest SNF without HIE. The robust study design will allow estimation strongly indicative of causation. The results of the proposed project will be important regardless of our findings. It will be the first investigation of whether HIE participation among SNFs (1) improves the quality of care, (2) lowers health care costs, or (3) reduces income and racial disparities in the quality of care for ADRD patients. The information will be useful to policymakers, SNF and hospital executives, physicians, patients, and leaders of health information exchanges.

项目总结/摘要 每年有150万名熟练护理机构（SNF）在医疗保险收费中进行急性后护理， 阿尔茨海默病或相关痴呆症（ADRD）的服务受益人，占60%以上， 在国家营养基金中接受护理的受益人。ADRD患者通常面临独特的挑战，包括无法 描述他们的诊断和症状或参与护理计划，这可能有助于提高他们的健康水平。 住院后使用SNF的可能性和不良结局。住院后，ADRD患者 与没有ADRD的患者相比，出院到SNF的可能性高出四倍。SNF患者， ADRD的预后比其他SNF患者差，包括再住院率高，SNF时间长， 留，并降低被释放回社区的可能性。信息共享不足 SNF，医院和其他供应商之间的能力被认为有助于频率 这些事件。SNF没有资格通过Medicare和Medicaid EHR获得奖励金 激励计划，导致医院广泛采用卫生信息技术， 医生政策制定者正在积极推动HIE参与，作为提高质量的手段 在SNF的护理。然而，没有证据表明它有能力对ADRD的SNF患者这样做。这很可能 由于缺乏SNF参与HIE的可用数据，包括关键信息，如HIE的日期， 参与的在这个项目中，将使用一个新的数据源，包括所有HIE参与的日期 参与纽约州HIE的SNF，为期八年（2012-2019）。这些数据将被合并 与100%的医疗保险索赔的样本，所有受益人在国家谁收到照顾在SNF期间， 研究期间，研究SNF参与HIE与护理质量和成本之间的关系 对于ADRD患者。SNF参与HIE和护理质量之间的关系也将被讨论。 专门针对患有ADRD的双重杀手和少数民族进行了检查，他们更有可能接受 与其他医疗保险受益人相比，分散的护理质量较低。我们的研究设计利用了 差异中的差异框架使用SNF参与HIE的不同时间，并结合了 基于患者住所和最近SNF之间的差异距离的工具变量 有HIE和最近的SNF没有HIE。稳健的研究设计将允许估计强烈指示 因果关系无论我们的调查结果如何，拟议项目的结果都很重要。这将是第一 调查SNF中的HIE参与是否（1）提高了护理质量，（2）降低了医疗保健 成本，或（3）减少ADRD患者护理质量的收入和种族差异。这些信息将 对政策制定者、SNF和医院管理人员、医生、患者和卫生信息领导者有用 交流